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Nif1344,4644A- <br />Geod _ife. Gifear Sew;Cr. <br />NE Sec of State - Robert I3. Evnen <br />Filing Document #: 2006001317-2 Pages: 1 <br />Debtor Name: ELIGIO E TREVINO <br />Filing Date and Time: 06/30/2020 10:59 AM <br />Notice of State Tax Lien <br />202004488 <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Iien.This lien will expire and <br />become unenforceable 10 years after the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Nebraska ID Number <br />48421308 <br />Federal ID Number <br />Lien Serial Number <br />12057203 <br />Len Filed With: <br />® Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX -XX -7016 <br />Soouses Social Security Number <br />Date of Lien <br />June 26, 2020 <br />Len Type: <br />®ore naf ❑ Continuation <br />08/13/2019 <br />County <br />HALL <br />I corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ELIGIO E TREVINO <br />526 ROUCH LANE <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2012 <br />08/13/2019 <br />$345.00 <br />S86.25 <br />$84.81 <br />516.06 <br />Individual <br />2013 <br />08/13/2019 <br />$560.00 <br />$140.00 <br />$120.86 <br />820.86 <br />Individual <br />2014 <br />08/13/2019 <br />$467.00 <br />$116.75 <br />$86.79 <br />670.54 <br />Individual <br />2015 <br />08/13/2019 <br />$509.00 <br />$127.25 <br />S79.28 <br />715.53 <br />Individual <br />2016 <br />08/13/2019 <br />$576.00 <br />$144.00 <br />$72.43 <br />792.43 <br />Individual <br />2017 <br />08/13/2019 <br />$665.00 <br />$166.25 <br />$63.68 <br />894.93 <br />Total <br />$4.410.35 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State 01 Nebraska in determining the amount shown to be due. <br />and that the taxpayer has tailed to pay the amount due alter demand. This Notice of State Tax Lien is an effective lien and serves to contrive the priority of <br />the States interest in the affected property of the taxpayer. <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />06/26/2020 (308)632-1208 <br />Date Phone Number <br />06/26/2020 <br />Tido <br />Date <br />4.494-1974 Rev, 9.20'e Supelsodes 4.9491974 Rev. 84013 <br />